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Psychiatry > First Aid Psych Clerkship > Flashcards

First Aid Psych Clerkship Flashcards

1
Q

Delusions of persecution/ paranoid delusions

A

CIA is after me and tapped my phone

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2
Q

Ideas of reference

A

TV characters are speaking directly to me

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3
Q

Delusions of control

A

Thought broadcasting: thoughts are being heard by others

Thought insertion: belief that others’ thoughts are being placed in one’s head

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4
Q

Delusions of grandeur

A

I am the all-powerful son of god

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5
Q

Delusions of guilt

A

I am responsible for all of the world’s wars

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6
Q

Somatic delusions

A

Belief that one is infected with a disease or illness

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7
Q

Ddx of psychosis

A 
Psychotic disorder due to another medical condn
Substance/med-induced psychotic disorder
Delirium/dementia
Bipolar disorder
Major depression
Schizophrenia and subsets
Schizoaffective disorder
Delusional disorder
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8
Q

Medical causes of psychosis

A

CNS disease- cerebrovascular disease, MS, neoplasm, Alzheimer, Parkinson, Huntington, tertiary syphilis, epilepsy, encephalitis, prion, neurosarcoidosis, AIDS

Endocrinopathies- Addison/Cushing, hyper/hypothyroidism, hyper/hypocalcemia, hypopituitarism

Nutritional/ Vitamin def- B12, folate, niacin

Other- Connective tissue disease, SLE, temporal arteritis, porphyria

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9
Q

Substances that can cause psychosis

A 
Anesthetics
Antimicrobials
Corticosteroids
Antiparkinonian agents
Anti-convulsants
Antihistamines
Anticholinergics
Antihypertensives
NSAIDs
Digitalits
Methylphenidate
Chemotherapeutic agents
Alcohol
Cocaine
Hallucinogens (LSD, Ecstacy)
Cannabis
Benzos/ Barbiturates
Inhalants
PCP (phencyclidine)
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10
Q

Schizophrenia

A

Positive symptoms- hallucinations, delusions, bizarre behavior, disorganized speech (respond well to typical antipsychotics)

Negative symptoms- flat or blunted affect, anhedonia, apathy, logia, and lack of interest in socialization (atypical antipsychotics help more with this)

Cognitive symptoms- impaired attention, executive function, and working memory

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11
Q

Phases of schizophrenia

A

Prodromal- declined function –> more socially withdrawn and irritable –> may have physical complaints, new-found interest in religion or the occult

Psychotic- perceptual disturbances, delusions, and disordered thought process/content

Residual- mild hallucinations or delusion, social withdrawal, and negative symptoms

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12
Q

DSM V criteria for schizophrenia

A

Two or more for AT LEAST 1 MONTH; but duration of illness for 6 MONTHS

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms

With at least one of them being 1, 2, or 3

if <1 mo: brief psychotic disorder
if 1-6mo: schizophreniform disorder

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13
Q

5 A’s of schizophrenia

A
  1. Anhedonia
  2. Affect (flat)
  3. Alogia (poverty of speech)
  4. Avolution (apathy)
  5. Attention (poor)
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14
Q

Pathways

A

Prefrontal cortical/ mesocortical (inadequate dopaminergic response responsible for negative symptoms)
Mesolimbic (excess dopaminergic response responsible for positive symptoms)
Tuberoinfundibular (blocked by antipsychotics- causes gynecomastia, galactorrhea, sexual dysfunction, etc)
Nigrostriatal (blocked by antipsychotics- causes Parkinsonism- tremor, rigidity, slurred speech, akathisia, dystonia, and other abnormal movements)

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15
Q

Other neurotransmitters in Schizophrenia

A

Increased: serotonin and NE

Decreased: GABA and glutamate

Imaging shows enlargement of ventricles and diffuse cortical atrophy and reduced brain volume

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16
Q

Schizophrenia- treatment

A

First gen (typical) antipsychotics: chlorpromazine, fluphenazine, haloperidol, and perphenazine- treats + symptoms

Second gen (atypical) antipsychotics: aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone

People who are treated with second gen antipsychotics require evaluation for metabolic syndrome: checking weight, BMI, fasting blood glucose, lipid assessment, and blood pressure

High potency- more risk of EPSE, low potency- extra risk of anticholinergic and antiadrenergic side effects

17
Q

Treatment of Side effects

A

Anticholinergics for EPSEs- benztropine, diphenhydramine

Benzodiazepines, and beta-blockers: especially for akathisia

18
Q

Weight-neutral second gens

A

Aripiprazole and ziprasidone

19
Q

Thioridazine

A

Retinal pigmentation at high doses

Chlorpromazine- can cause deposits in the lens and cornea

20
Q

Schizoaffective disorder

A

Unique because delusion or hallucinations are present for 2 weeks IN THE ABSENCE OF mood disorder; however mood symptoms otherwise are present for the majority of psychotic illness

21
Q

Prognosis (best to worst)

A

Mood disorder with psychotic features > Schizoaffective disorder > Schizophreniform disorder > Schizophrenia

22
Q

Brief psychotic disorder

A

1 day to 1mo of psychosis

Not diagnosed as brief psychotic disorder if patient has underlying personality disorder (e.g. borderline) wherein they may have transient, stress-related psychotic experiences

23
Q

Delusional disorder

A

Usually non-bizarre delusions
Daily functioning NOT significantly impaired
Does not meet the criteria for schizophrenia as described previously

One or more delusions for at least one month

Treatment: generally independent, supportive therapy; antipsychotic meds

24
Q

Culture-specific psychosis

A

Koro: penis recedes into body - Southeast Asia
Amok: violent outburst followed with suicide - Malaysia
Brain fag: Headache, fatigue, eye pain, and other somatic disturbances in male students- Africa

25
Q

MDD

A 
5/9 SIGECAPS criteria for at least 2 weeks
Sleep (up or down)
Interest
Guilt
Energy
Concentration
Appetite (up or down)
Psychomotor agitation or retardation
Suicidal ideation
26
Q

Manic episode

A

3/7 or 4/7 (if mood is only irritable) for at least 1 week or any during if hospitalization or psychotic

Distractibility
Irritability/ irresponsibility
Grandiosity
Flight of ideas
Agitation (psychomotor)
Sleep (reduced)
Talkativeness
27
Q

Hypomanic

A

Similar to mania except:

Lasts at least 4 days
No marked impairment in social or occupational functioning
Does not require hospitalization
No psychotic features

28
Q

MDD

A

Decreased CSF levels of 5-HIAA (metabolite of serotonin)

REM sleep shifted earlier in the nigh and longer duration- with reduced stages 3 and 4 (slow wave sleep)

Potentially increased sensitivity of beta adrenergic receptors in the brain

29
Q

Bipolar I disorder

A

Only requirement is episodes of mania (though most individuals also have episodes of depression this IS NOT required)

30
Q

Pharmacotherapy for Bipolar I

A

Lithium- mood stabilizer; reduces suicide risk

Can also use carbemazepine and valproic acid as mood stabilizers

Atypical antipsychotics (risperidone, olanzapine, quetiapine, and ziprasidone) are also used for acute manic episodes

ECT- best treatment for pregnant women with mania
May require more than 20 treatments

31
Q

Bipolar II

A

History of at least one HYPOmanic episode and one or more major depressive episode
(if there was even one prior manic episode then it is bipolar I)

If only minor hypomanic or depressive episode for > 2 years- then cyclothymic disorder

32
Q

Rapid cycling

A

At least four mood episodes within 12 months (manic, hypomanic, and depressed)

33
Q

Peripartum onset

A

Happens during pregnancy or within 4 weeks following delivery

34
Q

Persistant depressive disorder

A 
2 or more of the following for greater than 2 years without more than 2 month of being asymptomatic
CHASES
Concentration (poor)
Hopelessness
Appetite (increased or decreased)
Sleep (increased or decreased)
Energy (low)
Self-esteem (low)
35
Q

Disruptive Mood Dysregulation Disorder (DMDD)

A

Symptoms must have started before age 10; diagnosis can be made between ages 6-10
Cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder

Psychiatry (4 decks)

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